<div class="span4 box">

    <div class="content-wrap">
        <h6>Create Account</h6>
        
        <?php if ($this->successmessage != ''): ?>
            <div class="alert alert-success">
                <i class="icon-ok-sign"></i> <?php echo $this->successmessage; ?>
            </div>
        <?php endif; ?>

        
        <?php if (count($this->errorMessage) > 0): ?>
            <div class="alert alert-error">
                <?php foreach ($this->errorMessage as $erroValue): ?>
                    <div class="text-left">
                        <i class="icon-remove-sign"></i>
                        <?php echo $erroValue; ?>
                    </div>
                <?php endforeach; ?>
            </div>
        <?php endif; ?>



        <form action="<?php echo $this->url(array('module' => 'default', 'controller' => 'login', 'action' => 'signup'), null, TRUE); ?>" method="post">
            <?php echo $this->form->name; ?>
            <?php echo $this->form->phone; ?>
            <?php echo $this->form->email; ?>
            <?php echo $this->form->password; ?>
            <?php echo $this->form->user_confirmpassword; ?>
            <a href="<?php echo $this->url(array('module' => 'default', 'controller' => 'login', 'action' => 'index'), null, TRUE); ?>" class="forgot">Log in</a>

            <button type="submit" class="btn-glow primary login">
                Create Account
            </button>
        </form>
    </div>
</div>
